tbuckley/cabot-search huggingface dataset:
Abstract 9499: Clinical Outcomes With Initial Thoracic Endovascular Aortic Repair versus Initial Medical Therapy for Acute Uncomplicated Type B Aortic Dissection in the United States
Authors: Hope Weissler, Oyomoare Osazuwa-Peters, Melissa Greiner, Natalie C Hardy, Panagiotis Kougias, Sean OBrien, Daniel B Mark, William S Jones, Eric A Secemsky, Andrew Vekstein, Sherene Shalhub, Firas Mussa, Manesh R Patel, Sreekanth Vemulapalli
Journal: Circulation (2022)

Introduction: Thoracic endovascular aortic repair (TEVAR) has increasingly been used for uncomplicated type B aortic dissection (uTBAD) despite limited supporting data. We compared outcomes after a strategy of initial TEVAR vs. initial medical therapy in patients with uTBAD. Methods: Index acute uTBAD admissions from 2011-2018 were identified using 100% Medicare inpatient claims. Initial TEVAR was defined as TEVAR within 30 days of admission. Complicated and non-acute TBAD were excluded. Outcomes included survival, cardiovascular hospitalizations, aorta-related and repeat aorta-related hospitalizations, and aortic interventions. Propensity score inverse probability weighting (IPW) was used to reduce the effects of treatment selection bias in the data. The primary analyses were landmarked at 30 days to avoid survival time bias; a sensitivity analysis used TEVAR status as a time-dependent variable to account for deaths in the first 30 days. Results: Of 7,105 patients with eligible index admissions for acute uTBAD, 1,140 (16.0%) underwent initial TEVAR. Receipt of initial TEVAR was significant associated with geographic region, non-Medicaid dual eligibility, and institutional TEVAR volume as well as certain comorbidities. After IPW, mortality was similar for the two strategies out to 5 years (HR 0.95, 95% CI 0.85 to 1.06), while aorta related hospitalizations were modestly increased with the TEVAR strategy (HR 1.12, 95% CI 0.99 to 1.27). In the sensitivity analysis including deaths within the first 30 days, initial TEVAR was associated with lower mortality over a period of 1 year (aHR 0.86, 95%CI 0.74-0.997, p=.045), 2 years (aHR 0.85, 95%CI 0.75-0.96, p=.01), and 5 years (aHR 0.87, 95%CI 0.79-0.97, p=.008). Conclusions: We found that a significant minority of uTBAD patients undergo initial TEVAR, which may be associated with lower risk of mortality when deaths within the first 30 days are included. These outcomes, and the reasons why some patients receive initial TEVAR while others do not, remain incompletely characterized. These findings, along with factors related to anatomy, peri-procedural complications, adequacy of medical therapy, patient preferences, and cost effectiveness, need to be assessed in a prospective trial in the US population.
Abstract 9265: Real-World Disparities in Remote Follow-Up of Cardiac Implantable Electronic Devices and Impact of the Covid-19 Pandemic: A Single Center Experience
Authors: H Immo Lehmann, Krishan Sharma, Roma Bhatia, Guoping Li, Joshua Lang, Jagmeet Singh, Theofanie Mela
Journal: Circulation (2022)

Introduction: Remote monitoring (RM) of cardiac implantable electronic devices (CIEDs) has been shown to improve cardiovascular morbidity and mortality. To date, no studies have investigated disparities in utilization and delivery of RM. This study was performed to investigate if racial and socioeconomic disparities are present in CIED RM. Methods: Retrospective observational cohort study at a single tertiary care center in the United States. Patients who received a newly implanted CIED or device upgrade between 01/17 to 12/20 were included. Patients were classified as RM positive when they underwent at least ≥2 remote interrogations per year during follow-up. Results: Of all eligible patients, 2520 patients were included and 35% were female. The mean follow-up was 25 months. Mean age was 71±14 years. Pacemakers constituted 66% of implanted devices, while 26% were ICDs, and 8% CRT-Ds. Most patients (83%) were White non-Hispanic (WNH) patients. During follow-up, 66% of patients were classified as RM positive. In an adjusted regression model, these patients were younger (p=0.025) and more frequently had an ICD (HR=1.68; p&lt;0.001). RM positive patients more frequently had an advanced college degree (HR=1.27; p=0.026) and used the online patient portal (HR=2.22; p&lt;0.001). They lived in counties with higher median income (p=0.040) and were more frequently WNH patients (p=0.002). In a Cox regression analysis, RM status was associated with death (HR=0.487, p&lt;0.001, Figure). During the years of the COVID-19 pandemic, RM positive patients increased and influence of income and race decreased. Conclusions: Despite being offered to all patients at implantation, significant disparities were present in CIED RM in this cohort. Disparities were partly reversed during COVID-19. Further studies are needed to examine health center and patient specific factors to overcome these barriers, and to facilitate equal opportunities to participate in RM.
Abstract 9460: Comparing Mortality Outcomes With Different Rate Controlling Agents in Patients With Atrial Fibrillation
Authors: Andres Cordova, Gary Shmorgon, Danielle Olonoff, Sruti Akula, Debanik Chaudhuri
Journal: Circulation (2022)

Introduction: There is lack of information regarding the mortality benefits between different medications in patients with permanent atrial fibrillation (AF). Purpose: We aimed to identify if there is any difference in mortality between the use of different rate controlling medications in patients with permanent AF. Methods: We identified patients with permanent AF without history of heart failure (HF) by using the TriNetX research database which provides information from electronic medical records from several health care institutions primarily based in the United States. Patients were divided in 4 cohorts, those taking metoprolol, diltiazem, carvedilol, or atenolol. Propensity score matching (PSM) was used to equilibrate the cohorts based on past medical history and medications. The cohorts were compared amongst each other after PSM. Results: There was no difference in mortality, emergency room visits, or hospitalizations with the use of different rate-controlling medications. Conclusion: This study suggests that there is no difference in mortality with the use of metoprolol, carvedilol, atenolol, or diltiazem in patients with permanent AF without history of HF.
Abstract 9529: METTL3 Mediates Ang-II Induced Cardiac Hypertrophy Through Accelerating Pri-miR-221/222 Maturation in m6A Way
Authors: Rui Zhang, Yangyang Qu, Zhenjun Ji, Chunshu Hao, Yamin Su, Yuyu Yao, Wenjie Zuo, Xi Chen, Mingming Yang, Genshan Ma
Journal: Circulation (2022)

Background: METTL3, a core catalytic enzyme in m6A, is involved in a variety of cardiovascular diseases. However, whether and how METTL3 plays a role during Angiotensin II (Ang-II) induced myocardial hypertrophy is still unknown. Methods: Neonatal rat cardiomyocytes (NRCMs) and C57BL/6J mice were treated with Ang-II to induce myocardial hypertrophy. qRT-PCR and Western blots were used to detect the expression of RNAs and proteins. Genes function was verified by knockdown and/or overexpression respectively. Luciferase and RIP assays were used to verify interactions among multiple genes. Wheat germ agglutinin (WGA), hematoxylin and eosin (H&amp;E) and immunofluorescence were used to examine myocardial size. m6A methylation was detected by a colorimetric kit. Results: METTL3 and miR-221/222 expression and m6A levels, were significantly increased in response to Ang-II stimulation. Knockdown of METTL3 or miR-221/222 could completely abolish the ability of NRCMs to undergo hypertrophy. The expression of miR-221/222 was positively regulated by METTL3, and the levels of pri-miR-221/222 that bind to DGCR8 or form m6A methylation were promoted by METTL3 in NRCMs. The effect of METTL3 knockdown on hypertrophy was antagonized by miR-221/222 overexpression. Mechanically, Wnt/β-catenin signaling was activated during hypertrophy and restrained by METTL3 or miR-221/222 inhibition. The Wnt/β-catenin antagonist DKK2 was directly targeted by miR-221/222, and the effect of miR-221/222 inhibitor on Wnt/β-catenin was abolished after inhibition of DKK2. Finally, AAV9-mediated cardiac METTL3 knockdown was able to attenuate Ang-II induced cardiac hypertrophy in mouse model. Conclusions: Our findings suggested that METTL3 positively modulates the pri-miR221/222 maturation process in m6A dependent way and subsequently activates Wnt/β-catenin signaling by inhibiting DKK2, thus promoting the Ang-II induced cardiac hypertrophy.
Abstract 297: Chronic Oral Anticoagulant Use By Emergency Medical Services Patients In The United States
Authors: Henry Wang, Mengda Yu, Ching Min Chu, Travis Sharkey-Toppen, Madison Hyer, Michelle Nassal, Alix Delamare, Jonathan Powell, Lai Wei, Ashish R Panchal
Journal: Circulation (2022)

Objective: Oral anticoagulant (OAC) use raises risk of death in life-threatening conditions such as hemorrhagic stroke and trauma, including traumatic brain injury. Only limited data describe the characteristics of individuals who use OACs. We sought to describe the national characteristics of Emergency Medical Services (EMS) patients with a history of OAC use. Methods: We used the 2018-2020 ESO data set, a national EMS electronic health record system. We included adults (age≥18 years) receiving 911 prehospital emergency care. OAC use included warfarin, dabigatran, rivaroxaban and apixaban. We determined the incidence of EMS calls by OAC users as well as their variation by EMS agency. We compared EMS call, patient, and response characteristics between OAC and non-OAC users, including primary impressions and hospital diagnoses. Results: Among 2,100 EMS agencies, there were 16,244,550 adult 911 prehospital events, including 948,671 by OAC users (58 per 1,000 events). OAC call incidence varied by EMS agency; median 53 per 1,000 events (IQR 27 to 83). Compared with non-OAC users, OAC users were more likely to be &gt;70 years (64.6% vs. 30.3%, OR 4.19, 95% CI: 4.17 to 4.21), white race (77.4% vs. 65.8%, OR 2.62, 95 CI: 2.47 to 2.78) and non-Hispanic (84.4% vs. 78.0%, OR 2.66, 95% CI 2.63 to 2.69). Calls involving OAC users were more likely at nursing homes (17.9% vs. 9.1%, OR 2.16, 95% CI: 2.14 to 2.17) but less likely to involve trauma (17.8. vs. 21.6%, OR 0.787, 95% CI: 0.783 to 0.791) or cardiac arrest (1.2 vs. 1.4%; OR 0.89, 95% CI: 0.87 to 0.90). Among OAC users, the most common EMS primary clinical impressions were chest pain (7.4%), altered mental status (7.3%), injury (6.5%), abdominal pain (4.3%), and brain injury (2.8%). Among the 67,567 OAC prehospital encounters linked to hospital data, the most common primary discharge diagnoses were: ICD10 R00-R99 signs and symptoms (23.1%), I00-I99 circulatory diseases (19.9%), and J00-J99 respiratory diseases (10.1%). Conclusions: 1 in 17 adult prehospital encounters involve OAC users. While OAC use was common in high-risk populations, presentation with injury was less common. These results characterize the presentation of this high-risk population in EMS care.
Abstract 9783: Relationship Between Abnormal P Wave Axis, Chronic Obstructive Pulmonary Disease And Mortality In The General Population
Authors: Richard Kazibwe, Muhammad Ahmad, Luqman Arafath Thazhathuveetil Kunahamed, Haiying Chen, Joseph Yeboah, Elsayed Z Soliman
Journal: Circulation (2022)

Background: Vertical P-wave axis is frequently observed in the electrocardiograms (ECGs) of patients with chronic obstructive pulmonary disease (COPD). However, it is unclear whether its presence modifies the association of COPD with mortality. Methods: The analysis included 7,359 participants with ECG data from the Third National Health and Nutrition Examination Survey (NHANES-III) who were free of cardiovascular disease (CVD) at enrollment. Abnormal P-wave axis (aPWA) was defined as values above 75° from digitally recorded and centrally read ECGs. COPD was self-reported as either prior history of emphysema or a current diagnosis of chronic bronchitis. National Death Index was used to identify the date of death and cause of death. Multivariable Cox proportional hazard analysis was used to examine the association of COPD with all-cause mortality among study participants stratified by aPWA. Results: About 5.8% (n=422) and 21.8% (n=1,607) of the participants had COPD and aPWA at baseline, respectively. Over a median follow-up of 14 years, 2,435 deaths occurred. Participants with concomitant presence of aPWA and COPD (n=172) experienced higher death rates (73.9 per 1,000 person-years (PY)) compared to those with either COPD or aPWA alone (36.4 per 1,000 PY and 31.1 per 1,000 PY), respectively. In multivariable-adjusted models, there was a significant COPD by aPWA interaction (p=0.04). A stronger association between COPD and mortality was observed in the presence, compared to the absence, of aPWA. Similarly, a stronger association between aPWA and mortality was observed in the presence, compared to the absence, of COPD ( Figure) . Conclusions: Concomitant presence of aPWA and COPD carries a higher risk of mortality. P-wave axis, reported routinely on ECG printout, may identify a subgroup of COPD patients who are at a higher risk of poor outcomes. Further research is needed to examine whether intensive control of risk factors and disease management modify this risk.
Abstract 9575: TOTUM-070 Hypocholesterolemic Effect Linked to Intestinal Cholesterol Absorption Inhibition. An in vivo and in vitro Study
Authors: Cedric Langhi, Yolanda F Otero, Florian Le Joubioux, Bruno Guigas, Sébastien PELTIER, Pascal Sirvent
Journal: Circulation (2022)

TOTUM-070 (T070) is a patented blend of five plant extracts designed to act in combination to prevent hypercholesterolemia. Previous study in dyslipidemic hamster model fed a High Fat High Cholesterol (HFHC) diet for 12 weeks demonstrated that supplementation with T070 at 3,5% to 5% in the diet (n=16 per group) reduced serum non-HDL cholesterol compared to HFHC group (-38%, p&lt;0,001 and -47%, p&lt;0,001, respectively) as well as serum triglyceride levels (-30%, n.s and -46%, p&lt;0,05, respectively). We aimed to decipher the mechanisms of action of T070 both in vivo and in vitro. First, the chemical characterization of T070 by HPLC-UV/MS analyses led to the identification and quantification of 37 biomolecules such as oleuropein, oleanolic acid or chlorogenic acid. Total RNA sequencing analysis of livers from the HFHC and T070 5% supplemented groups highlighted 511 genes with significant different expression level between groups. Among canonical pathways identified, 19 genes implicated in metabolism were differentially regulated with T070. Several functional tests were performed in hamster fed with T070 5% for 12 weeks in comparison to HFHC group (n=14 per group). Dosage of lipoprotein lipase activity ex vivo did not show any difference between groups. Results from hepatic triglyceride production test detected no effect of T070. However, an oral fat tolerance test showed that post-prandial hypertriglyceridemia was significantly reduced by 40% (p&lt;0,01) in T070 group following olive oil gavage compared to the HFHC hamsters. Finally, in vivo intestinal [4- 14 C]-Cholesterol absorption test demonstrated a 12% reduction (n.s) with T070 5% compared to HFHC group. In vitro investigations were assessed on differentiated human enterocyte Caco2 cells. Incubation with T070 at 1g/l for 1h acutely reduced [1,2- 3 H(N)]-cholesterol uptake by 30% in Caco2 cells (p&lt;0.01). Pharmacological inhibition of cholesterol transporter NPC1L1 abolished the effect of T070 on cholesterol uptake. There was no effect of T070 on NPC1L1 protein expression in Caco2 cells, suggesting T070 blocked directly NPC1L1 activity. Altogether, our results demonstrate that hypocholesterolemic effect of T070 is mediated by inhibition of intestinal cholesterol absorption.
Abstract 9596: An Investigation of Differences in Ideal Cardiovascular Health Between Sexual Minority and Heterosexual Adults: Findings From the National Health and Nutrition Examination Survey (2007-2016)
Authors: Billy A Caceres, Yashika Sharma, Rohith Ravindranath, Ipek Ensari, Carl Streed
Journal: Circulation (2022)

Introduction: There is growing evidence that sexual minority (e.g., lesbian, gay, bisexual) adults are at higher risk of cardiovascular disease (CVD) than heterosexual adults. Research on the cardiovascular health (CVH) of sexual minority adults has primarily examined differences in the prevalence of individual CVH metrics rather than comprehensive measures. Therefore, we investigated sexual identity differences in ideal CVH among adults (ages 18-59) in the United States using the American Heart Association’s (AHA) Life’s Simple 7; a composite measure of ideal CVH. Methods: We analyzed cross-sectional data from the National Health and Nutrition Examination Survey (2007-2016). Questionnaire, dietary, and physical examination data were used to assess the seven metrics included in the Life's Simple 7 measure. Participants received a score of 0 (poor), 1 (intermediate), or 2 (ideal) for each CVH metric and scores were summed to calculate ideal CVH scores (continuous; range 0-14). We ran sex-stratified regression models adjusted for demographic characteristics and survey year to examine sexual identity differences in ideal CVH scores and ideal CVH (i.e., odds of meeting ideal criteria for ≥5 CVH metrics). Results: The sample included 12,832 participants with a mean age of 39.2 (±11.95) of which 5.7% were sexual minority. Compared to heterosexual women, bisexual women had lower ideal CVH scores ( B = -0.65, 95% CI = -1.02, -0.27) and they were also less likely to meet criteria for ideal CVH (AOR = 0.66, 95% CI = 0.47-0.93). Gay men had higher ideal CVH scores than heterosexual men ( B = 0.61 95% CI = 0.01, 1.21). Gay (AOR = 2.05, 95% CI = 1.16-3.62) and bisexual (AOR = 2.15, 95% CI = 1.16-3.99) men were more likely than heterosexual men to meet criteria for ideal CVH. Conclusions: This is the first representative study to investigate sexual identity differences in ideal CVH. Bisexual women were at higher risk of CVD than heterosexual women, which was attributed to higher odds of current tobacco use and obesity. Gay and bisexual men were at lower risk of CVD than heterosexual men. Future longitudinal research is needed to examine factors that might contribute to CVH disparities among bisexual women. Clinical interventions to reduce CVD risk among bisexual women are needed.
Abstract 9620: External Validation of Deep Learning-Based Echocardiography Algorithms to Automate View Selection and Annotation of the Echocardiogram
Authors: Kanako Teramoto, Chung-Lieh Hung, Matthew Frost, Sara Svedlund, Antti Saraste, Camilla A Hage, Lauren Nelson, Maria Lagerstrm Fermr, Li-ming Gan, Yoran M Hummel, Chanchal Chandramouli, Lieng Ling, Inder S Anand, Mark Richards, Lars H Lund, Sanjiv J Shah, Carolyn S Lam, Jasper Tromp
Journal: Circulation (2022)

Background: Manual measurements of echocardiography are time-consuming, error-prone, and highly user-dependent - all of which can be overcome with deep learning (DL) algorithms. Methods: We validated the automated DL measurement of the left ventricle (LV) and left atrial (LA) global longitudinal strain (GLS) and 20 conventional echocardiographic measurements using the Us.ai DL workflow. The workflow uses convolutional neural networks (CNNs) to automatically classify 2D videos and Doppler images with accuracies between 0.91-0.99. Separate CNNs automatically annotate and assess individual videos and images. We validated automated measurement in (1) an internal test set and (2) externally against core-lab measurements in the multinational PROMIS-HFpEF study. We compared the association of automated and manual parameters with N-terminal pro-B-type natriuretic peptide (NT-proBNP) in PROMIS-HFpEF. Results: The DL workflow successfully analysed 198 studies with an average of 7.8 minutes per study, with 100% reproducibility in the external validation set. In the internal validation set (N=86), automated LA (r=0.77, mean absolute error [MAE]=8.9%) and LV (r=0.91, MAE=2.8%) GLS showed good agreement with manual measurements. In the external dataset, automated measurements showed good agreement with the manual measurements, with an MAE range of 6.8 mL for LV volumes, 7.1% for LV ejection fraction, and 1.7 for the ratio of the mitral inflow E wave to the tissue Doppler e' wave ( Table ). Automated strain measurements showed good agreement (LV GLS: r=0.74, MAE=2.7%, and LA GLS: r=0.80, MAE=4.8%) with core lab measurements in PROMIS-HFpEF. Lastly, automated and manual measurements were similarly associated with NT-proBNP. Conclusions: DL-based algorithms can successfully classify and annotate echocardiographic studies, including LA and LV GLS. DL algorithms might increase reproducibility and democratise the use of strain measurements in clinical practice.
Abstract 9260: Rate of Progression of Aortic Stenosis in Patients With Cirrhosis
Authors: Nathaniel J Elsner, Abdulrahman Nazif, Huseyin E Arman, Saad Ali, George Revtyak, Ankur Kalra, Joseph Zenisek, Anjan Sinha, Rolf Kreutz, Kyle Frick
Journal: Circulation (2022)

Introduction: There is currently no published data studying the effect that cirrhosis may have on the rate of progression of aortic stenosis (AS). We hypothesize that AS may have accelerated progression in patients with cirrhosis compared with the general population due to high stroke volumes, hyperdynamic left ventricular function, and a pro-inflammatory state. The aim of this study is to determine the rate of progression of AS in patients with cirrhosis, elucidate risk factors, and assess progression based on the severity of cirrhosis as determined by Model for End Stage Liver Disease (MELD-Na) scores. Methods: This single center retrospective study included 48 patients with the diagnosis of cirrhosis and at least mild AS confirmed by two or more transthoracic echocardiograms (TTEs) taken ≥ 6 months apart. Historical data describing rates of AS progression in non-cirrhotic patients were used for comparison. Results: There was not a significant difference in the rate of AS progression between patients with cirrhosis and those without (table). Using univariate regression analysis, the yearly rate of aortic valve area (AVA) decline was positively correlated with the diagnosis of hyperlipidemia (HLD) (r=.228, P=0.047, B=0.116), initial AVA (r=0.504, P&lt;0.001, B=0.224), initial left ventricular outflow track to aortic valve velocity time integral ratio (LVOT:AV VTI) (r=0.519, P&lt;0.001, B=0.75) and initial left-ventricular stroke volume index (LV-SVI) (r=0.385, P=0.0070, B=0.0070). The yearly decrease of the LVOT:AV peak velocity ratio was inversely correlated with beta-blocker use (r=0.313, P=0.030, B=-0.047). There was not a significant relationship between MELD-Na scores and the rate of AS progression. Conclusion: Patients with cirrhosis can expect a similar rate of AS progression compared with those without cirrhosis. A higher initial LV-SVI and a history of HLD were both associated with faster AS progression in our study cohort.